Beckhardt R N, Murray J G, Ford C N, Grossman J E, Brandenburg J H
Department of Surgery, University of Wisconsin Hospital and Clinics, Madison.
Head Neck. 1994 May-Jun;16(3):232-9. doi: 10.1002/hed.2880160305.
The relationship between preoperative pulmonary function tests (PFTs) and postoperative aspiration and deglutition complications in supraglottic laryngectomy (SL) has not been adequately analyzed. The effects of numerous other variables are either controversial or have not been studied.
A retrospective chart review was performed on 46 SL patients, analyzing preoperative PFTs and arterial blood gases, demographic factors, stage of disease, extended resections, cricopharyngeal myotomy, hyoid preservation, neck dissection, and postoperative radiotherapy with regards to aspiration and deglutition problems.
Eighteen (39%) patients had no problems, 15 (33%) had moderate problems, and 13 (28%) had severe problems; of these, 39 (85%) were ultimately successful with no further swallowing dysfunction, whereas seven (15%) suffered intractable aspiration difficulties. Decreasing FEV1/FVC was significantly correlated with a poorer outcome, as was a greater number of pack-years of smoking. The effect of FEV1/FVC was shown to be independent from pack-years, whereas the converse was not clearly demonstrated. Extensions of the standard procedure did not correlate significantly with increased problems.
An FEV1/FVC less than 50% signifies a greater risk for severe aspiration and deglutition complications, although it must be regarded as one factor among many in determining operability. With careful attention to reconstruction, extensions of the standard SL procedure can be safely performed.
声门上喉切除术（SL）术前肺功能测试（PFTs）与术后误吸及吞咽并发症之间的关系尚未得到充分分析。许多其他变量的影响存在争议或尚未得到研究。
对46例接受声门上喉切除术的患者进行回顾性病历审查，分析术前肺功能测试和动脉血气、人口统计学因素、疾病分期、扩大切除术、环咽肌切开术、舌骨保留、颈部清扫以及术后放疗与误吸和吞咽问题的关系。
18例（39%）患者无问题，15例（33%）有中度问题，13例（28%）有严重问题；其中，39例（85%）最终成功，无进一步吞咽功能障碍，而7例（15%）患有顽固性误吸困难。FEV1/FVC降低与较差的结果显著相关，吸烟包年数较多也与较差结果显著相关。FEV1/FVC的影响显示独立于吸烟包年数，反之则未得到明确证实。标准手术的扩大与问题增加无显著相关性。
FEV1/FVC低于50%表明严重误吸和吞咽并发症的风险更大，尽管在确定可手术性时它必须被视为众多因素之一。通过仔细关注重建，声门上喉切除术标准手术的扩大可以安全地进行。
